Fam Pract Manag. 2005 Apr;12(4):72.
- Choosing the right legal structure
- Setting up a new practice
- How to build more maternity care into your practice
Choosing the right legal structure
I am setting up a legal structure for my practice. What options do I have?
The most common choices are a sole proprietorship, a partnership, a limited liability company (LLC) or a corporation. Forming and operating a corporation or an LLC is more complicated and costly than a sole proprietorship or partnership, but these structures limit the owners’ personal liability for business debts and court judgments against the business. Corporations and LLCs are good options for business owners who run a risk of being sued by customers or clients or piling up a lot of business debt, or who have a lot of personal assets they want to protect from business creditors.
For more information, go to the Small Business Administration Web site at http://www.sba.gov or call 800-827-5722.
Editor’s note: Look for a feature article on this topic in an upcoming issue of FPM.
Setting up a new practice
I’m thinking of starting my own practice but don’t know where to begin. Do you have any information that would help me?
If you are planning to start your own practice, here are some tasks to complete:
Make sure to obtain accounting and legal advice;
Do a market analysis to find a location that will reach the greatest number of potential patients;
Begin applying for provider ID numbers as soon as you have chosen your geographic location.
There are two publications devoted specifically two this topic. The AAFP’s On Your Own: Starting a Medical Practice from the Ground Up has comprehensive information about starting a business, including financing options, personnel issues, fees and contracting, medical records, office design and more. Go to http://www.aafp.org/newpractice.xml for more information or to order it online. The AMA also has a publication titled Starting a Medical Practice, Second Edition. Go to https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod170060 to order the AMA publication online.
How to build more maternity care into your practice
I want to increase the amount of maternity care I provide, but with the current size and makeup of my patient population, I don’t have the capacity. How can I trim my panel size?
The first step is to set a target for your intended number of deliveries each month, as that defines the number of ob patients you want to attract. For this example, we’ll assume eight deliveries per month.
These eight deliveries will cause approximately four interruptions of your office hours each month; the time of each will vary, of course. If we assume two hours of interruption per delivery, this results in a loss of an average of eight 15-minute office visits per week, or 384 visits in a 48-week work-year (you’ll be needing those four weeks of vacation). I suggest reducing your office schedule by eight visits per week and holding those open for rescheduling office visits that are “bumped” by deliveries.
You’ll also need to provide an average of 12 prenatal visits for each patient. Eight deliveries a month over an 11-month year (remember that month of vacation) means you’ll have 88 ob patients to see those 12 times. Bottom line: you’ll need to accommodate 1,056 prenatal visits in your schedule.
The 384 rescheduled office visits and 1,056 prenatal visits equal 1,440 appointments. If the average patient sees the doctor 2.5 times per year, the demand for maternity care would be roughly equivalent to the care you provide for 576 patients, or about 20 percent to 25 percent of the average family physician’s workload (assuming there are no midlevel providers sharing the load).
Since it may take you six to 10 months to attract enough ob patients to meet your target, you should reduce the number of non-ob patients you see gradually, if possible. You could close your practice to new non-ob patients from a health plan or two, and you could close your practice to new Medicare patients. In each case, attrition would reduce your non-ob patient count over time. Keep in mind that because Medicare patients use more services, you shouldn’t reduce the size of your Medicare panel by as many patients as you would for a commercial payer. In terms of demand, 200 Medicare patients are roughly equivalent to the 576 average patients you need to trim from your panel.
Alternative approaches would be to simply drop your lowest paying plan or hire a midlevel provider to help keep up with the demand created by the new maternity care patients.
* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.
Copyright © 2005 by the American Academy of Family Physicians.
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